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Vaccination against poliomyelitis in Brazil from 2011 to 2021: successes, setbacks, and challenges ahead
Maria Rita Donalisio1, Alexandra Crispim Boing2, Ana Paula Sayuri Sato3
1Departamento de Saúde Coletiva, Faculdade de Ciências Médicas, Universidade Estadual de Campinas. R. Tessália Vieira de Camargo 126, Cidade Universitária Zeferino Vaz. 13083-887 Campinas SP Brasil. rita.donalisio@gmail.com.
Insights
Childhood polio vaccination coverage declined significantly in Brazil between 2011 and 2021, especially in vulnerable regions and during the COVID-19 pandemic, increasing reintroduction risks.
Area of Science:
- Public Health
- Epidemiology
- Health Policy
Background:
- Childhood vaccination coverage (VC) has declined, raising public health concerns.
- Polio vaccination is critical for preventing disease reintroduction.
Purpose of the Study:
- To analyze temporal trends in polio vaccine coverage in Brazil (2011-2021).
- To map vaccination coverage geographically, including the COVID-19 pandemic period.
- To identify regions with declining VC and social vulnerability.
Main Methods:
- Ecological study using interrupted time series (STI) and spatial analysis.
- Data from the National Immunization Program Information System (2011-2021).
- Bayesian models for VC distribution and Moran index for spatial clusters.
Main Results:
- A consistent reduction in VC observed across all Brazilian regions.
- More pronounced drops in North and Northeast regions, particularly during the COVID-19 pandemic.
- Significant VC declines linked to states and regions with higher social vulnerability post-2019.
Conclusions:
- Declining VC poses an imminent risk of wild polio virus reintroduction in Brazil.
- Addressing these challenges requires strengthening the Brazilian Health System (SUS).
- Targeted interventions are needed for vulnerable populations and regions.
Abstract:
The drop in childhood vaccination coverage (VC), including poliomyelitis, has become a health concern. The objective was to analyze the temporal trend of coverage of the three doses of the polio vaccine in the first 12 months of life between 2011 and 2021, in addition to mapping vaccination coverage in Brazil, including the COVID-19 pandemic period. An ecological study was carried out using interrupted time series (STI) techniques and spatial analysis, with data from the National Immunization Program Information System. The VC trend was adjusted by the Newey-West variance estimator according to the federated units and the Brazilian Deprivation Index. The VC distribution was estimated by Bayesian models and the spatial clusters by the global and local Moran index, identifying areas of lower coverage in the health regions. There was a reduction in the VC over the period in all regions, being more pronounced in the North and Northeast regions and during the Covid-19 pandemic. The biggest drops were identified in states and health regions with greater social vulnerability after 2019. The drop in VC shows that the risk of reintroduction of the wild virus is imminent and the challenges need to be faced with the strengthening of the Brazilian Health System (SUS).
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